Back to Journals » Clinical Interventions in Aging » Volume 5

Antithrombotic therapy in very elderly patients with atrial fibrillation: Is it enough to assess thromboembolic risk?

Authors Guo Y, Wu Q, Zhang L, Yang T, Zhu P, Gao W, Zhao Y, Gao M

Published 14 May 2010 Volume 2010:5 Pages 157—162

DOI https://doi.org/10.2147/CIA.S9399

Review by Single-blind

Peer reviewer comments 1


Yutao Guo1*, Qiang Wu2*, Lu Zhang1, Tingshu Yang1, Ping Zhu1, Wenqian Gao1, Yuexiang Zhao1, Meng Gao1

1Department of Geriatric Cardiology, 2Department of Clinical Administration, General Hospital of The Chinese PLA, Beijing, China; *Shared equal authorship

Abstract: Although attention has been given to thromboprophylaxis for atrial fibrillation (AF) in present treatment guidelines, practical, clinical antithrombotic therapy is poorly developed for very elderly patients. We reviewed the records of 105 consecutive patients with AF of mean age 85 years, to determine how the greatest benefits from antithrombotic therapy could be obtained in this group. The mean CHADS2 score in these patients was 3.1 ± 1.5. Before antithrombotic therapy, 21.0% of the patients had diseases with a risk of hemorrhage, 26.7% had diseases with a risk of thrombosis, and 8.6% had diseases with a risk of both hemorrhage and thrombosis. Moreover, 89 patients (84.8%) were receiving a single antiplatelet drug, 10 (9.5%) used aspirin plus clopidogrel, and six (5.7%) were taking an oral anticoagulant (OAC). Additionally, dual antiplatelet therapy was more commonly given to patients with permanent AF (paroxysmal and persistent versus permanent, 6.3% and 12.5% versus 30%, respectively, Chi-square = 8.4, P = 0.010). The incidence of adverse events was 25.7%, with thromboembolic events in 20.0% and hemorrhage in 5.7% of patients. There were no thromboembolic events in those patients taking OACs, but 33% of patients who took OACs had bleeding complications. It is difficult to choose appropriate antithrombotic strategies in very elderly patients. Both the thrombotic risk and the bleeding risk should be considered for helping such patients derive optimal benefit from thromboprophylaxis for AF.
Keywords: atrial fibrillation, elderly, antithrombotic therapy, hemorrhage

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]